BILL ANALYSIS Ó
SB 319
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Date of Hearing: August 19, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
SB 319
(Beall) - As Amended July 7, 2015
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| |Health | |19 - 0 |
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Urgency: No State Mandated Local Program: YesReimbursable:
No
SUMMARY: This bill expands the duties of the foster care public
health nurses to include monitoring and oversight of the
administration of psychotropic medication to foster children, as
specified. Specifically, this bill:
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1)Authorizes a provider of health care to disclose medical
information to a foster care public health nurse to coordinate
health care services and medical treatment for a minor who has
either been taken into temporary custody, had a petition filed
with the court, or been adjudged a dependent child or ward of
the juvenile court, as specified.
2)Requires the foster care public health nurse and the child's
social worker to consult, collaborate, and share information
in a timely manner to ensure that the child's physical,
mental, dental, and developmental needs are met.
3)Requires that a foster care public health nurse have access to
a child's medical, dental, and mental health care information
in order to allow that nurse to fulfill his or her duties.
4)Requires a foster care public health nurse, at the request of
a nonminor dependent, to assist him or her in making informed
decisions about his or her health care by, at a minimum,
providing educational materials.
5)Adds to the duties of a foster care public health nurse the
monitoring of each child in foster care who is administered
one or more psychotropic medications, as specified.
FISCAL EFFECT:
1)Ongoing costs of approximately $12 million ($3 million GF) to
DCHS for public health nurses to collaborate with social
workers and to monitor, review and document information
related to the administration of psychotropic medications,
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assuming an average caseload of 1:200.
2)Ongoing non-reimbursable costs of approximately $6 million
($4.85 million GF) for county social workers to consult,
collaborate and share information with foster care public
health nurses. (Proposition 30 exempts the State from mandate
reimbursement for realigned programs, however, legislation
that has an overall effect of increasing the costs already
borne by a local agency for realigned programs, including
child welfare services, apply to local agencies only to the
extent that the State provides annual funding for the cost
increase.)
3)Onetime costs of $45,000 ($22,000 GF) and ongoing costs of
$7,000 ($3,500 GF) to DHCS to develop curriculum and train
public health nurses.
COMMENTS:
1)Purpose. This is one of four bills proposing a set of reforms
aimed at curbing excessive and inappropriate authorization and
administration of psychotropic medications among foster youth.
The author states that nearly one in four foster children and
56 percent of children in group homes are receiving
psychotropic drugs, often without adequate oversight. The
author further states that without adequate oversight, these
medications can cause irreversible damage, and many youth
experience long-term side effects, including diabetes, heart
disease, irreversible tremors, tics, weight gain and
drowsiness. This bill utilizes public health nurses to oversee
the medical monitoring of psychotropic drugs to increase
oversight and reduce the number of children prescribed these
drugs.
2)Background. AB 1111 (Chesbro), Chapter 147, Statutes of 1999,
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required DSS to establish a program of public health nursing
within the child welfare services program. This program - the
Health Care Program for Children in Foster Care- is located in
county child welfare agencies and probation departments, and
serves to assist in meeting the medical, dental, mental
health, and developmental needs of foster youth.
Foster care public health nurses work with child welfare
caseworkers and probation officers to promote access to
comprehensive health services. Federal funding requirements
stipulate that the services provided by foster care public
health nurses must be limited to health-related case
management and not involve the provision of direct health care
services. Under the supervision of supervising public health
nurses, foster care public health nurses consult and
collaborate with social workers and probation officers to
provide services such as: medical and health care case
planning; expediting referrals for medical, dental, mental
health and developmental services; and helping to develop and
maintain each child's Health and Education Passport, which
provides a summary of all obtainable health and education
information for foster youth that travels with each youth
throughout out-of-home placement. According to the County
Welfare Directors Association of California, there are
approximately 250 foster care public health nurses working
throughout the state.
Research has repeatedly indicated that children and youth in
foster care face higher levels of inappropriate or excessive
medication use, and that those foster youth placed in group
home settings are particularly vulnerable to over-prescription
and misuse of psychotropic medications. Data provided by the
Department of Health Care Services (DHCS) indicate that, in
fiscal year 2013-14, almost 15% of all foster youth in
California ages 0 to 20 years old were prescribed at least one
psychotropic medication; for foster youth ages 12 through 20,
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this rate was almost 25% and for youth placed in group homes,
it was 50%.
3)Related Legislation. The following bills are part of a
four-bill package (including this bill) regarding the use of
psychotropic medication for children in foster care. All are
before this Committee today.
a) SB 238 (Mitchell), 2015, requires DSS to develop
expanded training for foster parents, social workers, group
home administrators, and others involved in the care and
oversight of dependent children on issues related to
psychotropic medications.
b) SB 253 (Monning), 2015, modifies juvenile court
practices and requirements regarding the authorization of
psychotropic medications for foster youth by, among other
things, requiring clear and convincing evidence that
administration of the medication is in the best interest of
the child and, in specified circumstances, prohibiting the
authorization of psychotropic medication administration for
a child unless a second opinion is obtained from a child
psychiatrist or behavioral pediatrician.
c) SB 484 (Beall), 2015, requires DSS to compile and post
on its Internet Web site specified information regarding
the administration of psychotropic medications to children
placed in group homes and to establish a methodology for
identifying group homes with high levels of psychotropic
drug use. Further establishes certain requirements for
those group homes.
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Analysis Prepared by:Jennifer Swenson / APPR. / (916)
319-2081